Healthcare Archives | Powers Law Firm

ALERT: CMS Updates FAQ Guidance to allow Hospital Billing of Clinic Visit Code G0463 in Connection with Remote Visits During COVID-19

On Tuesday, July 28, CMS updated the COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing to provide guidance on billing HCPCS code G0463 when a physician is providing a remote service to a patient in the patient’s home, which has been designated as a provider-based department. As we noted last week (see our memorandum of July 22), CMS has taken inconsistent positions on this issue in its Office Hours calls—first stating that billing a G0463 is not permitted, then stating that it is, and then reversing course again to prohibit it. In its first official written guidance on the subject, CMS changed course once again.

Latest Turn in Hospital Billing of Clinic Visit Code G0463 in Connection with Telehealth Visits During COVID-19

Click here for a PDF version of this memo.

On Tuesday, July 21, in a CMS “Office Hours” COVID-19 call, CMS provided the latest guidance on billing HCPCS code G0463 when a physician is providing a telehealth service to a patient in the patient’s home, which has been designated as a provider-based department. The guidance represents a departure from previous oral advice provided by CMS and is the latest twist in a confusing mix of written guidance and oral advice on the subject of how hospitals should bill for these visits.

Powers Attorney Rebecca Burke to Present Webinar on Remote Patient Monitoring

Powers attorney Rebecca Burke will present a Strafford webinar titled “Remote Patient Monitoring: Navigating Reimbursement Changes, Privacy and Security Risk, Ensuring Compliance” on Thursday, August 6 at 1:00 pm.

Powers Principal Barbara Williams to Present at 340B Coalition Summer Conference

Powers Attorneys Paul Moorehead and Kathleen Hatfield Author Opinion Piece in Law360

Powers attorneys Paul Moorehead and Kathleen Hatfield authored an opinion piece in Law360 on the benefits of telehealth for tribal communities.

Powers Attorney Steve Kuperberg Authors Piece in 340B Report

Powers Counsel Steve Kuperberg authored a piece, entitled “340B and Dispute Resolution–Challenges and Opportunities,” in the 340B Report, the only subscription-based news service that provides breaking news and analysis about the federal 340B Drug Pricing Program.

Click here to read the full piece.

Medicare Telehealth Policies During the COVID-19 Pandemic

By Rebecca Burke, Esq. and Megan La Suer, Esq

Current as of June 1, 2020

Click here to download a PDF of this article.

Over the last several weeks, Powers has been reporting on the telehealth expansion during the COVID-19 pandemic. (More information is available on the Powers website.) The Coronavirus Aid, Relief, and Economic Security Act (CARES Act), enacted on March 27, 2020 and the Centers for Medicare and Medicaid Services (CMS) Interim Final Rule (IFR), issued on March 31, both contain significant telehealth provisions. CMS has also been issuing a steady stream of guidance regarding implementation of these provisions, although many questions still remain unanswered. On April 30, 2020 CMS issued a new series of updates including new waivers and a new IFR. This series of Q & As address many of the temporary telehealth provisions that apply during the COVID-19 public health emergency (PHE) including the April 30, 2020 announcements. Powers will be updating this document as the Administration continues to issue additional guidance. The information contained in this document shall not be considered legal advice but should be instructive for providers seeking to be in compliance with laws, regulations, and guidance that are being issued and changed frequently.

Powers Principal Bobby Silverstein Interviewed in ADA 30 Year Anniversary Article

Powers Principal Bobby Silverstein was interviewed in a recent article titled the “The ADA at 30: Looking Back and Ahead,” in the Society for Human Resource Management (SHRM) Magazine.

Proposed Changes to Medicare Hospital IPPS for Federal Fiscal Year 2021

This memorandum summarizes key changes to the acute-care hospital IPPS proposed by the Centers for Medicare and Medicaid Services (CMS) for FFY 2021. CMS issued a display copy of the proposed rule on May 11, 2020. The proposed rule is scheduled to be published in the Federal Register on May 29. Comments are due by 5:00 pm Eastern on July 10, 2020. The tables and data files for the proposed FFY 2021 IPPS rule are available on the FFY 2021 Proposed Rule Home Page.

Webinar on Indian Tribal Telehealth Opportunities

On May 14, Powers attorneys from the Indian tribal governments and health care groups hosted a webinar on Indian tribal telehealth opportunities, including recent opportunities presented by the CARES Act.

Navigating Medicare Coverage for Remote Patient Monitoring

By Rebecca Burke

Remote patient monitoring (RPM) technology has been proven to enhance quality of care for patients with chronic conditions and to reduce hospital readmissions. During the COVID-19 pandemic it has become especially relevant as a strategy for ensuring vulnerable patients can be monitored at home without the need to visit their physician’s office or the hospital.

Diagnostic Services in the era of COVID-19: The New Landscape

While the impact of the COVID pandemic on elective surgery has received significant attention from the lay media, the impact of the crisis on diagnostic imaging and diagnostic testing—although likely at least as severe—has been less in the public eye (with the exception of clinical laboratory services, which are not addressed here). And while the expanded availability and coverage of telehealth has the potential to somewhat mitigate the impact of sharp reductions in in-person office visits and other medical services, at least some component of many diagnostic imaging and other diagnostic tests are not the beneficiaries of any such technological buffer.Read More

Hospital Billing of Telehealth Visits During COVID-19 Pandemic

Updated May 12, 2020

In an Interim Final Rule published on March 31, CMS authorized physicians to bill for telehealth visits as if they were office visits in response to the COVID-19 public health emergency (“PHE”). Since then, many hospitals have pointed out that there was no mechanism for a hospital to bill an originating facility fee for a telehealth service performed by a physician from a hospital outpatient department or other provider-based clinic. Consequently, these services were reimbursed less when performed from a hospital site, as compared to a physician office site. (The UB92 hospital outpatient billing form does not provide for billing of a telehealth originating site facility fee because the patient is not physically present at the hospital.) This issue was raised repeatedly by providers during the CMS “Office Hours” teleconferences, during which CMS acknowledged the inconsistency and promised to release additional guidance.

Designing a Coherent Policy Consistent with Resident Privacy Rights and New Federal and State Requirements

As the COVID-19 crisis has unfolded, Skilled Nursing Facilities (SNFs) and Assisted Living Facilities (ALFs) have faced new transparency requirements imposed by both federal and state authorities that mandate certain specified disclosures of the COVID-19 status of residents and staff to other residents and their family members. Read More

CMS Interim Final Rule on COVID-19 Public Health Emergency Waivers

Click here to download a PDF of this article.

On April 30, 2020, CMS issued a display copy of an Interim Final Rule (IFR) to clarify certain policies and make regulatory changes in response to the COVID-19 PHE. At the same time, CMS announced new waiver authorities under the CARES Act and released other documents to further clarify policies during the pandemic. The significant changes are summarized below.

Powers to Host Webinar on Indian Tribal Telehealth Opportunities

Powers attorneys from the Indian tribal governments and health care groups will host a free webinar next week on Indian tribal telehealth opportunities, including recent opportunities presented by the CARES Act.

Resources on Coronavirus and EEO Laws Applicable to People with Disabilities

In response to the COVID-19 public health emergency, the U.S. Equal Employment Opportunity Commission (EEOC) and the Centers for Disease Control and Prevention (CDC) have compiled relevant information for employers and provided guidance on equal employment opportunity (EEO) laws applicable to people with disabilities and COVID-19. Those resources can be found at the links below.

Provider Program for Uninsured Reimbursement Begins

On April 27, the Department of Health and Human Services (HHS) opened the COVID-19 Uninsured Program Portal, where providers can sign up for reimbursement for testing and treating uninsured patients who had COVID-19 diagnoses on or after February 4, 2020. The funding is part of the legislative responses to the COVID-19 pandemic and will provide Medicare rates for COVID treatment. Providers may now enroll through the Program Portal at https://coviduninsuredclaim.linkhealth.com/.

CMS Announces Suspension of Advance Payment Program and Reevaluation of Accelerated Payment Program

On April 27, 2020, the Centers for Medicare and Medicaid Services (CMS) announced that it is suspending its Advance Payment Program to Part B suppliers and reevaluating the amounts that will be provided under its Accelerated Payment Program. Beginning on April 26, 2020, CMS will no longer accept any new applications for the Advance Payment Program, and CMS will reevaluate all pending and new applications for Accelerated Payments.

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